Provider Demographics
NPI:1497419907
Name:BENSON, GEETAL (PHD)
Entity Type:Individual
Prefix:
First Name:GEETAL
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 LINKS DR E
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5624
Mailing Address - Country:US
Mailing Address - Phone:917-757-5307
Mailing Address - Fax:
Practice Address - Street 1:353 LINKS DR E
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5624
Practice Address - Country:US
Practice Address - Phone:917-757-5307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024487103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist